fluid and electrolyte
normal calcium level
8.6-10.2
normal chloride level
97-107
normal magnesium level
1.3-2.3
which is the most common cause of symptomatic hypomagnesemia? a. burns b. alcoholism c. IV drug use d. sedentary lifestyle
B. alcoholism
the nurse is participating in the care of a client who has a PICC placed in the R arm. after cath placement, the nurse should complete what action? a. assess the clients BP on the right arm b. administer the prescribed IV fluids c. send the client for a chest xray d. obtain written consent for the procedure
C send the patient for a chest xray
Which solution is hypotonic? A. 5% NaCl B. LACTATED RINGERS C. 0.9% NaCl D. 0.45% NaCl
D. 0.45% NaCl
when a pt with a Mg concentration of 2.6 is being treated on a med surg unit. which tx should the nurse anticipate will be used? a. fluid restriction b. oral magnesium oxide c. dialysis d. IV furosemide
D. IV furosemide and NaCl LR for pts with adequate renal function****or Calcium gluconate
if a pt has been vomiting for 3 days what would their ABG's look like? a. Ph: 7.45 Paco2: 32 Hco3: 21 b Ph: 7.28 Paco2: 25 Hco3: 15 c. Ph: 34 Paco2: 60 Hco3: 34 d. Ph: 7.55 Paco2: 60 Hco3: 28
D. d. Ph: 7.55 Paco2: 60 Hco3: 28 pt is most likely demonstrating metabolic alkalosis by this point.
a client is to receive hypotonic IV solution in order to provide free water replacement. Which solution does the nurse anticipate administering? a. 0.45% NaCl b. 5% NaCl c. Lactaced Ringers d. 0.9% NaCl
a. 0.45% NaCl free water to excrete body wastes. at times hypotonic sodium solutions are used to treat hypernatremia and other hyperosmolar conditions. LR and NS are isotonic and 5% is Hypertonic
nurse is caring for a client with Potassium concentration of 6.0. the client is ordered to receive oral sodium and furosemide. what other order should the nurse anticipate giving? a. DC the IV LR's b. change the LR solution to 3% c. Increase the rate of the IV LR d. change the LR solution to 2.5% dextrose
a. DC the IV LR it is contributing to both the fluid volume excess and the hyperkalemia. LR contains Na and K which would worse the hyperkalemia and fluid volume excess.
when evaluating ABGs, which value is consistent with metabolic alkalosis? a. HCO 21 b. pH 7.48 C. paco 36 d. o2 95%
a. HCO 21 high pH and high plasma bicarb level. HCO is below normal. Ph is high PaCO and Oxygen are normal Ph 7.35-7.45 PaCO2- 35-45 HCo3- 22-26
a pt undergoing ETOH withdrawal, the nurse should monitor which lab closely? a. Mg B. Ca c. P d. K
a. Mg
which is an insensible mechanism of fluid loss? a. breathing b. urination c. bowel elimination d. nausea
a. breathing
hypokalemia can cause which symptom to occur? a. excessive thirst b. decreased sensitivity to digitalis c. production of concentrated urine d. increased release of insulin
a. excessive thirst kidneys wont concentrate the urine, causing dilute urine and excessive thirst. DEPLETES the release of insulin and decrease sensitivity does not occur.
the nurse is assigned to care for a patient whose serum Phosphorus level is 5.0. the nurse anticipates what electrolyte imbalance? a. hypocalcemia b. hyponatremia c. hypermagnesemia d. hyperchloremia
a. hypocalcemia
which factor increases BUN? a. hypothermia b GI bleeding C. decreased protein intake D. overhydration
b. GI bleeding along with decreased renal fx, dehydration, increased protein intake, fever and sepsis will have higher specific gravity*** 1.003-1.030 is normal
ABGs for a pt with severe pneumonia. which ABG would indicate resp acidosis? a. ph: 7.32 Paco2: 40 Hco3: 18 b. ph: 7.20 Paco2: 65 Hco3: 26 c. ph: 7.42 Paco2: 45 Hco3: 22 d. ph: 7.50 Paco2: 30 Hco3: 24
b. ph: 7.20 Paco2: 65 Hco3: 26
the nurse is analyzing the ECG rhythm tracing of a client experiencing hypercalcemia. Which ecg change is typically associated with this electrolyte imbalance? a. peaked T wave b. prolonged PR intervals c. elevated ST segments D. prolonged qt intervals
b. prolonged PR intervals HEART BLOCKS*** shortening of the QT intervals and ST segments
pt with acute renal failure and hypernatremia. in this case, which action can be delegated to the CNA? a. teach the client about increased fluid intake b. provide oral care every 2-3 hours c monitor for signs and symptoms of dehydration d. assess the client's weight daily for trends
b. provide oral care every 2-3 hours
a nurse is caring for a client in the ICU following a near drowning event in saltwater. the client is RESTLESS, LETHARGIC, DEMONSTRATING TREMORS. additional assessment findings include SWOLLEN AND DRY TONGUE, FLUSHED SKIN, AND PERIPHERAL EDEMA. what will the serum Na value be? a. 135 b. 125 c. 155 d. 145
c. 155
which percentage of Potassium excreted daily leaves the body by way of kidneys? a. 40% b. 20% c. 80% d. 60%
c. 80%
which condition might occur with respiratory acidosis? a. decreased pulse b. mental alertness c. increased ICP d. decreased BP
c. Increased ICP along with increased BP, Increased Pulse, decreased mental alertness
early signs of hypervolemia include a. decrease in bp b. moist breath sounds c. increased breathing effort and weight gain d. thirst
c. increased breathing effort and weight gain
a client is experiencing a severe anxiety attack and hyperventilating presents to the ED. the nurse should expect the clients Ph value to be? a. 7.30 b. 7.45 c. 7.35 d. 7.50
d. 7.50 pt is experiencing respiratory alkalosis.
a pt diagnosed with bulimia. the client is being treated for potassium concentration of 2.9. which statement made by the client indicates the need for further teaching? a. I will be sure to buy frozen vegetables when I grocery shop b. I will take a potassium supplement daily as prescribed c. a good breakfast for me will include milk and a couple of bananas d. i can use laxatives and enemas but only once a week.
d. i can use laxatives and enemas but only once a week hypokalemia is often caused by misuse of laxatives, diuretics, enemas and self induced vomiting eat food rich in K (fruit juices, bananas, melons, citrus fruits, fresh and frozen vegetables, lean meats, milk and whole grains)
when caring for a client at risk for F/E imbalances, which assessment finding is the highest priority for the nurse to follow up? a. weight loss of 4 lb b bp 96/53 c mild confusion d irregular heart bear
d. irregular heart beat Potassium, magnesium, and calcium can all cause dysrhythmias
a pt with cancer is being treated on the oncology unit for bilateral breast cancer and undergoing chemo. the nurse notes that the clients Ca concentration is 12.3. given the lab finding the nurse should suspect what? a. clients diet is lacking Ca rich food b. client has a history of ETOH abuse c. client may be developing hyperaldosteronism d. malignancy is causing the electrolyte imbalance
d. malignancy is causing the electrolyte imbalance. most common cause of hypercalcemia is malignancies and hyperparathyroidism. ETOH abuse is associated with HYPO***
the calcium concentration in the blood is regulated by which mechanism? a. androgens b. adrenal gland c. thyroid home d. parathyroid hormone
d. parathyroid hormone controlled by parathyroid hormone and calcitonin**
FVE labs
decreased everything***
what percentage of fluid in your body is water in young/middle age?
10%
normal sodium level
135-145
normal phosphorus level
2.5-4.5
normal bicarbonate level
24-31
normal serum osmolality
275-290
Normal Potassium level?
3.5-5
normal potassium level
3.5-5
factors affecting urine osmolality (increasing)
fluid volume deficit CHF acidosis prerenal failure
Which electrolyte is a major anion in body fluid? A CHLORIDE B. CALCIUM C. SODIUM D. POTASSIUM
A. CHLORIDE
Which electrolyte is a major cation in body fluid? A. POTASSIUM B. CHLORIDE C. PHOSPHATE D. BICARBONATE
A. POTASSIUM
clients diagnosed with Hypervolemia should avoid sweet or dry food because it? a. obstruct water elimination b. can lead to weight gain c. can cause dehydration d. increases the clients desire to consume fluid
A. obstructs water elimination
ONCOTIC PRESSURE REFERS TO THE... A. EXCRETION OF SUBSTANCES SUCH AS GLUCOSE THROUGH INCREASED URINE OUTPUT B. OSMOTIC PRESSURE EXERTED BY PROTEINS C. AMOUNT OF PRESSURE NEEDED TO STOP THE FLOW OF WATER BY OSMOSIS D. NUMBER OF DISSOLVED PARTICLES CONTAINED IN A UNIT OF FLUID
B. OSMOTIC PRESSURE EXERTED BY PROTEINS
which could be a potential cause of respiratory acidosis? a. hypoventilation b. vomiting c. diarrhea d. hyperventilation
a. hypoventilation d/t inadequate extretion of CO2
which condition leads to chronic respiratory acidosis in older adults? a. thoracic skeletal change b. erratic meal patterns c decreased renal function d. overuse of sodium bicarbonate
a. thoracic skeletal change
FVE s/s
acute weight pain dependent peripheral edema; shiny tight ascites distended jugular veins crackles increased BP bounding pulse, tachycardia *** SOB, increased RR, increased urine output
hyponatremia s/s
anorexia, n/v headache lethargy dizziness CONFUSION*** muscle cramps weakness muscular twitching seizures dry skin increase pulse, decrease BP weight gain edema
which client is at the highest risk for a fluid and electrolyte imbalance? a. 79 yr old client admitted w/ diagnosis of pneumonia b. 45 yr old who had a lap appy 24 hrs ago and is being advanced to a regular diet c. 82 year old who received all nutrition via tube feedings and whose meds include carvedilol and torsemide d. 66 year ols who has an open choley with a T-tube placed that is draining 125 ml of bile per shift.
c. 82 year old who received all nutrition via tube feedings and whose meds include carvedilol and torsemide 3 risk factors: Age, tube feedings and diuretic use (torsemide)
the nurse is instructing a client with recurrent hyperkalemia about following a potassium-restricting diet. which statement by the client indicates the need for additional instruction? a. i'll drink cranberry juice with my breakfast instead of coffee b. bananas have a lot of potassium in them, ill stop buying them c. i will not salt my food; instead i will use salt substitute d. i need to check to see whether my cola beverage has potassium in it.
c. i will not salt my food; instead i will use salt substitute use salt substitutes sparingly if they are taking other supplementary forms of potassium of potassium conserving diuretics. potassium rich foods should be avoided (legumes, whole gain breads, ean meat, milk eggs, coffee, tea, and cocoa) minimal containing potassium foods (butter, margarine, cranberry juice or sauce, ginger ale, gumdrops, or jellybeans, hard candy, root bear, sugar, and honey)
the nurse is caring for a client with severe diarrhea. the nurse recognizes that the client is at risk for developing which acid/base imbalance? a. metabolic alkalosis b. respiratory alkalosis c. metabolic acidosis d. respiratory acidosi
c. metabolic acidosis also caused by lower intestinal fistuals, ureterostomies, and use of diuretics; early renal insufficiency; excessive administration of chloride; and the administration of parenteral nutrition without HCO3 or HCO3 production solutes (lactate)
which statement accurately reflects a rule of thumb on which the nurse may rely in assessing a clients fluid balance? a. minimal intake of 2L/day b. minimal urine output of 10ml/hr c. minimal intake of 1.5L/day d. minimal urine output of 50ml/hr
c. minimal intake of 1.5L/day when fluid and foods are withheld IV fluids are usually prescribed (3L/day), minimal urine output may be <50ml/hr, minimal urine output MUST exceed 10ml/hr, minimal intake, as a rule of thumb, is <2L/day!*!
What is diffusion? a. process by which fluid moves across semipermeable member from area of low to high b. number of milliosmoles per liter of solution; expressed as milliosmoles per liter c. the process by which solutes move from an area of high to one or lower; does not require expenditure of energy
c. the process by which solutes move from an area of high to one or lower; does not require expenditure of energy
a client is being treated in the ICU 24 hours after having a radical neck dissection. the clients Ca is 7.6. which physical exam finding is consistent with Hypocalcemia? a. muscle weakness b. negative chvostek sign c. slurred speech d. presence of trousseau sign
d. presence of trousseau sign
Isotonic solutions 0.9% NaCl
expands the ECF; used in hypovolemic states, resuscitative efforts, shock, DKA, metabolic alkalosis Hypercalcemia mild Na+ deficit only solution that may be given with blood products similar to plasma
factors that affect serum osmolality (decreasing) Dilute
fluid volume excess acute kidney injury diuretic use adrenal insufficiency hyponatremia over hydration
factors affecting urine osmolality (decreasing)
fluid volume excess diabetes insipidus hyponatremia aldosteronism pyelonephritis acute tubular necrosis
Hypernatremia contributing factors
hypertonic tube feedings without adequate water supplements diabetes insipidus heatstroke hyperventilation watery diarrhea burns diaphoresis excess corticosteroid sodium bicarb salt water near drowning victims***
labs for FVD
increased Hgb and hct increased serume and urine osmolality and specific gravity (dehydrated) decreased urine sodium increased BUN/creatinine increased urine specific gravy and osmolality****
hypertonic solutions
increases ECF volume, decrease cell swelling highly hypertonic used only in critical situations to tx hyponatremia
FVE (fluid overload) hypervolemia contributing factors
kidney injury, HF, cirrhosis of the liver; excess of table salt, excessive Na+ containing fluids (hypertonic) 3% NS**** prolonged corticosteroids, severe stress, and hyperaldosteronism
Hyponatremia contributing factors
loss of GI fluids renal disease adrenal insufficiency excessive administration of d5w hypotonic tube feedings meds associated with water retention-oxytocin hyperglycemia heart failure
s/s of FVD
oliguria, concentrated urine dizziness weakness thirst and confusion muscle cramps sunken eyes Nausea increased temp; cool, clammy pale skin acute weight loss, decreased Skin turgor**** postural hypotension*** dry mucus membranes*** weak thready rapid pulse*** low BP***
what is the recommended route for giving potassium?
oral
hypotonic solutions 0.45% NaCl
provides Na+, Cl- and free water free water is desirable to aid the kidneys in elimination of solute tx hypertonic dehydration Na++ and Cl- depletion gastric fluid loss
factors that affect serum osmolality (increasing)
severe dehydration free water loss Diabetes Insipidus hypernatremia and hyperglycemia stroke or Head injury alcoholism burns
hypernatremia s/s
thirst elevated body temp swollen dry tongue and sticky mucous membranes hallucinations lethargy restlessness irritability simple partial or tonic clonic seizure pulmonary edema hyperreflexia twitching N/V/A increased pulse and bp
isotonic solutions LR Lactate (metabolized to HCo3) 5% dextrose in water-no electrolytes
used in tx of hypovolemia burns fluid lost as bile/diarrhea acute blood loss replacement*** LR should not be used in Lactic acidosis because the ability to convert the lactate in HCo3 is impaired**** do not give if pH >7.5*** contraindicated with Head injury d/t increase in ICP*** lactate is rapidly metabolized in HCo3
contributing factors for FVD (hypovolemia)
vomiting, diarrhea, anorexia, nausea fistulas, fever excess sweating burns, blood loss GI secreting decreased PO intake
